Pelvic Muscle Strength After Childbirth

Abstract

OBJECTIVE The objective was to estimate the effect of vaginal childbirth and other obstetric exposures on pelvic muscle strength 6–11 years after delivery and to investigate the relationship between pelvic muscle strength and pelvic floor disorders. METHODS Among 666 parous women, pelvic muscle strength was measured with a perineometer 6–11 years after delivery. Obstetric exposures were classified by review of hospital records. Pelvic floor outcomes, including stress incontinence, overactive bladder, anal incontinence, and prolapse symptoms, were assessed with a validated questionnaire. Pelvic organ support was assessed using the Pelvic Organ Prolapse Quantification system. Kruskal-Wallis tests were used to estimate the univariable associations of obstetric exposures and pelvic floor outcomes with peak muscle strength. Stepwise multivariable linear regression models were used to estimate the association between obstetric exposures and muscle strength. RESULTS In comparison with women who delivered all of their children by cesarean, peak muscle strength and duration of contraction were reduced among women with a history of vaginal delivery (39 compared with 29 cm H2O, P<.001). Pelvic muscle strength was further reduced after history of forceps delivery (17 cm H2O, P<.001). After vaginal delivery, reduced pelvic muscle strength was associated with symptoms of anal incontinence (P=.028) and pelvic organ prolapse on examination (P=.025); these associations were not observed among those who had delivered exclusively by cesarean. CONCLUSION Pelvic muscle strength almost a decade after childbirth is affected by vaginal delivery and by forceps delivery. Although statistically significant, some of the differences observed were small in magnitude.

Increasing Age Is a Risk Factor for Decreased Postpartum Pelvic Floor Strength

“…In fact, the caesarean group had a longer second stage compared to the vaginal group, A labored cesarean may reflect other factors, such as obstructive labor resulting in cesarean delivery. We found that 25% of cesareans had a decrease in PFS, in line with previous studies showing a decrease in strength in caesareans who labor 4,22 .…”

“…The reduction of pelvic muscle strength after vaginal delivery compared to cesarean has been reported in multiple studies 7,8,12,22 . The general consensus is that vaginal delivery reduces strength 4,7,8,10,23 . The finding of increasing age significantly impacting PFS reduction is novel.…”

“…PFS was measured using a Peritron™ perineometer, which is a 28mm diameter compressible probe connected to a handheld microprocessor. It provides readings of pelvic floor contraction in cm of H 2 0 with precision up to one decimal point, and it has been demonstrated to show reproducible and reliable measurements 4,16,17 . The resting vaginal pressure and two peak pressures were measured.…”

“…With the area of the average fetal head measuring 70-90 cm, it is clear that the LAM complex undergoes marked distention and deformation during childbirth 3 . Consequently, multiple studies have shown that pelvic floor weakness occurs following childbirth 4-6 . This effect seems to impact women more often following a vaginal delivery, compared to a cesarean delivery 4,7,8 .…”

Análise da distribuição multivetorial de cargas do assoalho pélvico feminino em diferentes populações

“…Estas são geralmente empregadas como (a) biofeedback da pressão da cavidade vaginal durante o tratamento (43), (b) ferramenta diagnóstica da pressão para diferenciar grupos de pacientes (continentes e incontinentes) (18,44), (c) resposta do sucesso ou não da terapia utilizada (45). Apesar de aparentemente correspondentes e serem ainda usadas na literatura sem distinção apropriada, a dinamometria é uma ferramenta mais sensível, precisa, direta e específica que a perineometria.…”